Imagine360 is currently seeking a Medical Claims Administrator to join our team! The Medical Claims Administrator coordinates the receipt, tracking, and documenting of stop loss claims submissions. Additional functions may include compiling reporting, communicating with third party administration staff, and processing claims.

Position Location: 100% remote

Responsibilities include but are not limited to:

Stop Loss Claims Management

• Compiles stop loss claim submissions and enters in claims system.
• Logs potential claim notices.
• Ensures all claim information is included in submission and follows up with third party administrator when necessary.
• Properly documents claim file.
• Compile periodic reporting for various stakeholders.

Claim Processing

• Review claims for appropriateness.
• Approve and facilitate funding with Finance.

Quality Assurance

• Recognizes, documents, and alerts appropriate supervisor of trends.
• Performs self-quality monitoring in order to develop and execute plans to meet established goals.
• Provides ongoing feedback to help optimize quality performance.
• Collaborates with others and cross-departmentally to improve or streamline procedures.
• Develops new or improves current internal processes to improve quality

Required Experience / Education:

• High School Diploma or GED required
  • Associates degree in Medical Billing and Coding or relative field preferred

• 2+ years of experience in administration and customer service required
  • Understanding of Medical Third Party Administration functions, Claims and Medical Terminology strongly preferred
• Working knowledge of computers including but not limited to Microsoft Office products
• Demonstrated organizational skills, problem solving, analytical skills and detail orientated

What can Imagine360 offer you?

• Multiple Health Plan Options, including a 100% employer paid premiums option
• 100% Company paid employee premiums for Dental, Vision, STA, & LTD, plus Life Insurance
• Parental Leave Policy
• 20 days PTO to start / 10 Paid Holidays
• Tuition reimbursement
• 401k Company contribution
• Professional development initiatives / continuous learning opportunities
• Opportunities to participate in and support the company's diversity and inclusion initiatives

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Imagine360 is a health plan solution company that combines 50+ years of self-funding healthcare expertise. Over the years, we've helped thousands of employers save billions on healthcare. Our breakthrough total health plan solution is fixing today's one-size-fits-none PPO insurance problems with powerful, customized, member-focused solutions.

Imagine360 is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.

**RECRUITMENT AGENCIES PLEASE NOTE: Imagine360 will only accept applications from agencies/business partners that have been invited to work on a specific role. Candidate Resumes/CV's submitted without permission or directly to Hiring Managers will be considered unsolicited and no fee will be payable. Thank you for your cooperation**